Scope of practice regarding wound closure

[LoopsRN2]

I have worked as a CSA for about 13 years, and our hospital is using scrub techs more often due to budget cuts within the last year. Our scrub techs have a variety of training, most being LPNS or CSTs. We have a few that hold no medical license or certification, and one has started to close skin. What do most hospitals do in your area with non-medical employees in this sense? I always thought that the surgeon could have delegate any task to whoever he/she wanted, however doesn't the hospital itself has a liablity in this also? The surgeons are NOT employeed by our hospital in this case.

[Rose_Queen, BSN, MSN, RN]

We allow certain STs to close skin. They are required to go through a training class, and maintain a competency sign off by a minimum of two surgeons.

[LoopsRN2]

We allow certain STs to close skin. They are required to go through a training class, and maintain a competency sign off by a minimum of two surgeons.

If you don't mind me asking, what kind of credentialing do the scrubs have that are close skin? Are they non-medical personel with on-the-job training,certified surgical techs, LPNS, CSA/CFA, or RNs?

[Rose_Queen, BSN, MSN, RN]

1 CFA, the rest are either CST or ST.

[jessrene, LPN]

We have a ST that is a LPN and she closes skin for certain doctor.

[Tiffany, RN, BSN]

Our hospital's policy is only MDs, PAs and RNFA can do wound closure. STs can operate skin staplers ONLY with the direct supervision of one of the above.

[tiny1]

We only use LPN's in our OR to scrub and assist the surgeons. Our top LPN scrub does all the skin closures for all doctors except one that always does his own. I think it would be up to your facilities protocol and at the surgeons discretion as to whom he chooses to close his wounds.

[shodobe]

We only use LPN's in our OR to scrub and assist the surgeons. Our top LPN scrub does all the skin closures for all doctors except one that always does his own. I think it would be up to your facilities protocol and at the surgeons discretion as to whom he chooses to close his wounds.

No, it shouldn't be up to a hospital to choose whether someone can close a wound. This only comes under the indviduals scope of practice. It not only puts the hospital in a liability issue but the individual could lose their creds to practice. Also, it isn't the surgeons choice on who closes or not. Come on people use some common sense here. Do you want to take that chance that the hospital would step up to the plate or even the surgeon to save your a** if a bad infection came up because you closed? They would certainly NOT! All hospitals look out for themselves and no one else. Even if the hospital would have a policy on this I would still question the legalities of it. There are states that allow some pretty stupid practices by individuals and personally I prefer to avoid those states.

[tiny1]

If the state board of nursing approves this and the facility offers classes and documentation that the nurse is comptent to suture, the physcian has determined that he wants this scrub to close for him, I see no legal issue as far as the nurse is concerned. Common sense tells me that if the facilities paperwork is giving you the authority to suture and your state board of nursing says it is within your scope of practice, the chances of being sued is no greater for suturing than any other duty that might be performed during a surgery.

[LoopsRN2]

If the state board of nursing approves this and the facility offers classes and documentation that the nurse is comptent to suture, the physcian has determined that he wants this scrub to close for him, I see no legal issue as far as the nurse is concerned. Common sense tells me that if the facilities paperwork is giving you the authority to suture and your state board of nursing says it is within your scope of practice, the chances of being sued is no greater for suturing than any other duty that might be performed during a surgery.

This has been a great thread! What I orginally wanted to know was relating to NON-nursing, Non-certified scrub techs closing skin, and if any of your hospitals currently allow this practice. I am wondering if a facility practices AORN recommended guidelines, where do on-the-job trained surgical assistants fall under? I don't think that they can inject a local anesthetic? That is medication administration....a nursing duty or certified tech duty. I thought closing skin fell under the same type of catagory.

[RNFA2012]

I have basically the same question...we st's that have been trained on the job with no certification and no formal training. They are being allowed to close patients...sometimes even making an RNFA move for them to close a patient. This is happening at op clinics in Mississippi but I cannot find any information that states if it is legal or not. Also does the st operate under the MD's license or the RN during surgery...

[LoopsRN2]

I have basically the same question...we st's that have been trained on the job with no certification and no formal training. They are being allowed to close patients...sometimes even making an RNFA move for them to close a patient. This is happening at op clinics in Mississippi but I cannot find any information that states if it is legal or not. Also does the st operate under the MD's license or the RN during surgery...

I have researched this over the last couple of years, and I have found a variety of practices. The one thing I that seems to be a common trend is that the role of the CSA/CSFA/RNFA/CRNFA is a dying field with an increase in difficulty getting reimbursed by insurance companies and budget cuts. I can't imagine that a surgical technician would ever operate under the RN license/malpractice etc (circulator I am assuming you mean?) during a surgery.